the_little_things.docx

The Little ThingsIt was the second time during this frigid December that the elderly Mr. Cheng was found lethargic by his son. Last week, he had injected too much insulin for his diabetes. This week, he'd omitted a dose of his lactulose for the cirrhosis from his advanced liver cancer.Each time, the EMTs treated Mr. Cheng in the ambulance, so by the time we saw him in the ER, he was already awake and cantankerous, itching to be discharged. He was fretfully anxious to leave immediately so he wouldn't miss his afternoon dialysis appointment in Chinatown. And he needed his morning dose of Nepro - the nutritional milkshake for dialysis patients."He's totally independent," the son told me. "He takes his meds, gets to his appointments, never misses dialysis. The home attendant does cooking and cleaning in the mornings."But two admissions in 2 weeks for medication errors was a blazing red flag. A frail, elderly man with complicated illnesses, taking high-risk medications, living alone - it was a recipe for disaster."Trust me," the son said with a tired smile, "he does not want to be in a nursing home."Mr. Cheng broke in, shaking his rail-thin arms vehemently. "No nursing home," he said, in his smattering of English. "I go home!"The social worker applied for increased home-attendant hours. Although the attendant couldn't administer meds, she could remind him to take them. It wasn't ideal, but at least Mr. Cheng was amenable. The catch was that it would take several days for t